Paralysis of the Face from DCI?

[Laurence Stein DDS]

I haven't had gross anatomy since 1970! My hat is off to all you MD and DMT types...it a lot to learn, remember and finally use.

Thanks for the compliments.

BTW, when I had to do my chamber tx. I was first checked for hidden diabetes. NADA.

The second, third, forth and sixth cranial nerves were all suspect. In fact, even using some sophisticated visual tests, the actual nerve that was affected was never confirmed. It seems that the muscles around the eye (except the abducens) have multiple functions and often those functions are a combination of several all contrubuting to the final action. All you need is some partial paralysis of a part of only one muscle to cause a misalignment of the eyes.

I had an MRI with and without contrast, no vascular defects within or outside the scull were noted.

It's still a mystery. The good news is that I can still catch those dang fish!

The neurologist first told my opthalmologist that he thought it was diabetes. Turned out to be wrong.

I think I'll go have a doughnut now!

Regards.

Larry Stein

 

[Laurence Stein DDS]

Suppose the face mask was adjusted too tight and the diver failed to maintain equal inside and outside pressure

Certainly you could end up with eccymosis within the eyes. But the lower mask edges would also pass directly over the distribution of the facial nerve as it traverses the face.

Wierd but is it possible?

Oldie dentist, newbie Dr!

Larry Stein

Just tryin to find a reason to stay up later

 

[gazzahawkes]

Hello all
I wont even pretend that ive heard half the medical terms you guys are bounding around,
However this year we have assessed two patients with dcs showing facial problems. In one case the patient was new to us and we didnt know wheather he had fallen off the ugly tree or just looked weird, Other dcs signs where prevalant Eg numb/tingle/balance impairment fatigue, and slow motor function. Just before evac having improved on 02 he saw himself in a mirror and was not happy, after treatment his face shape changed dramatically.
On admission we suspected a sting or insect bite as his cheeks where drooping and his lips looked swollen.

The second guy could not drink any fluids or chew properly without dribbling hence his visit to the chamber.

in both cases there was NO eveidence of sinus barotrauma or trauma to the ear,In both cases only one side was effected In both cases improvement came after one us tble 6.

So to all you Drs out there whats your thoughts?

Gary and john Koh tao

 

[kelpdiver]

Certainly facial nerve paralysis will give an odd appearance to the face as it will certainly "droop" on that side. And dribbling food/water goes with it, as the cheek and lip muscles don't work. As I mentioned previously, if you want to distinguish lesion of facial nerve (peripheral nervous system) from brainstem (central NS), assess the forehead muscles (assuming the patient hasn't been getting botox up there!).
The other case, with multiple other symptoms/signs, would need a good neurologic exam to sort out where the lesions/ deficits would be, and it can still be difficult. Balance problems can be from cerebellum, brainstem, spinal cord, peripheral sensory nerves, peripheral motor, etc. Don't know why the lips looked swollen.

Dr. Stein, as to your last observation, I don't think the mask would be low enough to compress any but the smaller, local branches of the nerves, except for the infraorbital, but you DDS's know better than me where all those nerves are, thankfully--just got a temporary crown 2 days before doing an advanced class this weekend.

This is a fun board.

Carl

 

[Laurence Stein DDS]

Kelpdiver,

Hi, I agree with you in your assessment of the neurologic symptoms. I threw the mask out as a "red herring" I've never heard of it but there are some masks that are wide enough to compress the parotid area and some masks extend almost to the lips/covering the entire cheek...this has to at least put pressure on branches of the facial nerve.

In the post by gazzahawkes, the tingliness and loss of balance would make me think of a sensory nerve problem. In the second case, the hypoglossal nerve and the glossopharyngeal nerve may have been involved as well as part of the facial nerve. I would be inclined to think of a central lesion

Larry Stein

 

[ROVengineer]

Hi all

After reading this thread I felt I must join this site & explain what happened to Me . I ,m certainly no doctor so forgive my medical speak!
On The Wednesday
Back in october this year I took on a dive to 34 m , not strenuous in any way , but I did slightly force my left ear to equalise on the descent .Was a conservative dive( well within dive limits ) with an extra long saftey stop .& no pains / strange sensations on the ascent.

Some time after the dive I had a slightly dull pain in my left ear ? Was so slight that I thought very little of it & was ( To Me ) of no concern.
On The Thursday
While eating at lunch noticed that the left side of my tongue had no tastae ..hmmm
Friday am
I woke & found the left side of my face very faintly numb. At this point i went to seek medical advice . As a child (25 years previous) I suffered from BellsPalsy for 18 months & instantly realised as my face began to actually get numb that this is what it was !! The doctor diagnosed ( didnt have a CAT or MRI scan )Bells Palsy & put me on a course of anti viral drugs ( Sorry cant remeber the name of them ). Within a few days of that friday my left side of my head was totally numb , full Bells Palsy , If you've never experienced Bells Palsy ( Its horrible ) As I knew already normally Bells Palsy lasts usually average of 3 months sometimes much longer, being that I had it for 18 months as a kid & also knowing that a having it a second time is somewhat rare I was amazed that withing only 5 to 6 weeks my face had its full sensation back ?????

Was this diving related ? I dont know

Was`this Bells Palsy ? I,m pretty sure it was

Pure coincidence ? Not sure .....but this site thread has been interesting . I like to know what the doctors in here think?

I havnt been diving since , partly due to being a touch paranoid of getting ' Bells Palsy' again , if the diving did cause it !!

Oh & BTW : The doctor said that people who get Bells Palsy for the second time have a very large % chance of never getting sensation back !!!!Hence the reason for being paranoid about going diving again.

Just to make things clear I had total paralysis of the left side of my Head & Numbness ??? & no taste feeling in my tongue

 

[ROVengineer]

Well I,m still waiting for some input here , so just posting this to get a reply

 

[gert7to3]

Kelpdiver mentioned Bell's Palsy in response #5. Bell's, coincident to the dive, was the first thing which came to my mind.

I'm an ophthalmic photographer, not a doc. However, I have documented Bell's related problems on numerous occasions. There is also the possiblilty of a small stroke, again coincident to the diving activity, further back the line from the facial nerves.

ROVengineer, have you checked your issue(s) out with a neurologist? There may be some better information available now.

 

[Laurence Stein DDS]

ROVengineer,

If your original Bell's Palsey was caused by a herpes type virus, it is possible that the virus did NOT go away as in most viral infections. Typically, herpes viruses go into a dormant phase..within the nerver root... during which there are no symptoms. Then they may activate....years later...especially during periods of stress or if your general immune system is compromised.

A prime example of this is Chickenpox. Persons who have had Chickenpox as a child are susceptible to "Shingles" (Herpes Zoster) infection...especially in middle to older age groups. The Zoster virus has been dormant in the sensory nerve roots in the spinal column for 30-40+ years. When the virus "reactivates", you will see a rash develop on the surface of the skin along the distribution of the affected spinal nerve. The rash is unilateral, affecting only one side of the body. Even when the rash disappears, the sufferer may be left with a painful neralgia that can persist for months.

It is possible to have a very mild chickenpox infection as a child and you may have no knowledge that you ever had the infection.

I would doubt that the diving was either the cause of your current problem or would make it worse. Most likely it is simply a coincidence that the dive and the palsey occurred in close proximity.

Unfortunately, the symptoms you present with can also be associated with a DCI type of incident or even a neuro-vascular episode and medical evaluation is indeed needed.

I would recommend that you follow up with a neurologist as previously suggested.

Along with antiviral drugs, some docs will also put the patient on a course of steroids to reduce the inflammation around the affected nerve and hopefully reduce the potential for more permanent damage.

Laurence Stein, DDS

 

[Laurence Stein DDS]

I had an interesting incident occur at my office to one of my staff about 6 months ago.

One of my assistants came to work one morning. Her eye was drooping/tearing. One side of her face was drooping. She complained of numbness of one side of her face, lips and tongue.

For a week prior to this, she had been complaining of a very severe "headache" on the same side as the neurologic symptoms.

I did a quick neuro check and along with the stated symptoms, she also exhibited a loss of balance.

Her symptoms suggested Bell's Palsey BUT...her symptoms seemed to indicate deficits in cranial nerves V, VI, VII and possibly VIII. Since I've always associated Bell's palsey with Cranial nerve VII (Facial nerve) and she had symptoms also associated with balance... Cr VI, sensation/feeling... Cr V, facial motor deficit... Cr VII, taste... Cr VII (Chorda Tympani), AND she had been having headaches up to and including the day of the incident, I couldn't rule out some sort of cerebro-vascular incident.

Rescue was called and after their evaluation, they recommended transport to the hospital where the ER docs still couldn't rule out other conditions other than Bell's Palsey. CT and MRI were done and finally they decided that is was, infact, Bell's Palsey.

She was put on Acyclovir and a week's worth of declining doses of cortisone. The medication started to show results in about 3-4 days and a month later there was no visible drooping.

The point of this story is that no one can just assume that a drooping face is a Bell's Palsey. If this occurred following a dive, there is no way a neurologic DCI could be ruled out and you would probably have to undergo hyperbaric treatment just to be on the safe side.

According to physicians I spoke to, even though Bell's Palsey is considered to be a Cranial Nerve VII condition, if the causitive agent is at the base of the skull where this nerve exits, it is in close proximity to a number of other cranial nerves and they too may be affected by the inflammatory response created (in this case by a virus).

Hope this helps.

Laurence Stein DDS